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Treatment and prevention of Yersinia enterocolitica and Yersinia pseudotuberculosis infection

INTRODUCTION

Yersinia species are gram-negative coccobacilli, which are facultative anaerobes [1]. Three species of Yersinia produce human illness: Y. pestis (the causative agent of human plague), Y. enterocolitica (the causative agent of yersiniosis), and Y. pseudotuberculosis. Y. enterocolitica and Y. pseudotuberculosis most commonly cause enterocolitis; Y. enterocolitica is the more common of the two species to cause disease.

The treatment of Y. enterocolitica and Y. pseudotuberculosis infection will be reviewed here. The epidemiology, microbiology, pathogenesis, clinical manifestations, and diagnosis of these infections and issues related to plague are discussed separately. (See "Epidemiology of Yersinia enterocolitica infection (yersiniosis)" and "Microbiology of Yersinia enterocolitica and Yersinia pseudotuberculosis" and "Clinical features and diagnosis of Yersinia enterocolitica and Yersinia pseudotuberculosis infection" and "Microbiology, pathogenesis, and epidemiology of plague (Yersinia pestis infection)" and "Clinical manifestations, diagnosis, and treatment of plague (Yersinia pestis infection)".)

TREATMENT

Optimal treatment strategies for Yersinia spp. infections are unclear. Although treatment appears not to impact mild intestinal disease, fecal shedding decreases following antimicrobial treatment [2]. This by itself does not justify treatment, as person-to-person transmission is rare. However, antimicrobial treatment may be lifesaving in invasive infections.

There has been one controlled trial of antimicrobial therapy for Y. enterocolitica infection and one for Y. pseudotuberculosis gastroenteritis [3,4]. Neither demonstrated a clinical benefit from treatment, though, in both treated groups, the pathogen was rapidly cleared from feces. In addition to these studies, treatment recommendations are based on susceptibility data and clinical case series.

In vitro studies — Yersinia susceptibilities vary with the serotype, and therapeutic decisions should be guided by the susceptibility pattern of the clinical isolate [1]. The Y. enterocolitica serotype most commonly associated with illness (O:3) usually produces chromosomally-mediated beta-lactamases and thus is resistant to penicillin, ampicillin, and most first generation cephalosporins [1,5]. Yersinia is also usually resistant to macrolides.
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